Good outcome from surgery for ampullary tumour

Background: Ampulla of Vater rumours are rare but usually resectable. There is debate as to the better surgical approach between the standard radical procedure, which provides adequate resection margins, and local resection, which may carry a lower mortality. This study reports the 16-year experienc e of a specialist unit with these tumours, and compares our results with th at of recently published series. Method: A retrospective review of patients admitted with an ampullary tumou r to the Hepatobiliary and Pancreatic Surgery Unit, Royal Adelaide Hospital , Adelaide, Australia, between January 1981 and April 1997. Results: Twenty-five patients (13 men, 12 women) of median age 65 years wer e admitted with an ampullary tumour to the unit during this period. The mos t common presentation was obstructive jaundice. Multiple endoscopic biopsy was found to be very reliable in distinguishing between benign and malignan t tumours. Five patients, all male, had benign neoplasms: three adenomas, o ne carcinoid and one gangliocytic paraganglioma. Transduodenal local excisi on was performed in four patients. One patient had a Whipple procedure resu lting in the only in-hospital death at 3 months. Twenty patients had adenoc arcinoma, of which 13 patients had a pancreaticoduodenectomy, two local exc isions, two palliative bypasses, two were unfit fur surgery and one decline d surgery. The resectability rate was 88%, with no operative mortalities. T he 5-year actuarial survival of patients who underwent radical resection wa s 49%. Conclusions: Proximal pancreaticoduodenectomy, preferably a pylorus-preserv ing procedure, is safe and effective in the treatment of ampullary carcinom a, with low operative mortality and good long-term survival. Local resectio n is only recommended for small benign tumours and for patients who may be unfit for radical surgery.